Lengthier resuscitation attempts improve survival rates

DALLAS – More patients are revived and
survive cardiac arrest when treated in hospitals that generally perform
resuscitation efforts for a longer amount of time, according to a new study
published in Lancet.

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Researchers studied records of 64,339
patients suffering an in-hospital cardiac arrest at 435 hospitals taking part
in the American Heart Association's Get With The Guidelines®-Resuscitation
program. As with earlier studies, the investigators found that most patients
who were successfully resuscitated responded early on during the arrest, but
they also noted that some survivors appear to require efforts that take more
time.

The overall median resuscitation time
was 12 minutes for patients who were revived, and 20 minutes in those who died.
The study also measured each hospital's tendency toward longer resuscitation
efforts overall by assessing the length of their attempts in non-survivors,
correlating this with the likelihood of survival in the overall group of
patients.

They found that patients at hospitals
with the longest median duration of 25 minutes for resuscitation efforts had a
12 percent higher likelihood of being revived compared with patients at
hospitals with the shortest median time of 16 minutes.

Patients who survived after longer
efforts did not appear to have substantially worse neurological functioning
compared to those who responded early.

"The duration of resuscitation
attempts for patients with cardiac arrest varies widely across hospitals," said
Zachary Goldberger, M.D., lead author of the study and an academic cardiologist
at Harborview Medical Center/University of Washington School of Medicine in
Seattle. "Unfortunately, there's been little evidence to guide clinicians on
when it may be best to terminate these efforts and this is one of the most
challenging decisions we face when caring for these patients."

It's estimated that between one and
five of every 1,000 patients hospitalized in Western countries will suffer a
cardiac arrest, with fewer than 20 percent surviving to discharge. Physicians
are often reluctant to continue resuscitation attempts given the often poor
outcomes for such patients, said study authors.

"Whether the improved survival rate we
found is due to the longer attempts or more standardized approaches to
resuscitation that lead to longer attempts at these hospitals is unclear," said
Brahmajee Nallamothu, M.D., senior author of the study, staff cardiologist at
the Ann Arbor VA Medical Center and associate professor in the Department of
Internal Medicine at the University of Michigan Health System in Ann Arbor.
"The optimal duration of resuscitation efforts for any individual patient
remains a bedside decision that requires careful clinical judgment. But our
findings suggest hospitals may need to consider whether efforts to
systematically increase their duration of resuscitation attempts through
protocols and standardized assessments of patients during the arrest may
improve survival in these high-risk patients."

The American Heart Association
Emergency Cardiovascular Care guidelines do not currently recommend a specific
duration for resuscitation attempts because there is not yet sufficient
scientific evidence to guide the ability to tell when further efforts would be
futile for an individual patient. However, the kind of information gathered in
the association's quality improvement programs like Get With The Guidelines-
Resuscitation, used in this study, helps ask the critical questions that can
improve care.

"New tools are being developed to help
us better recognize which patients are or are not responding to resuscitation
attempts," said Michael Sayre, immediate past chair of the American Heart
Association's Emergency Cardiovascular Care Committee. "We are learning from
studies like this one to help us improve our guidelines going forward. But for
the present, the clinical decision for each patient must be determined on an
individual basis by the healthcare providers caring for that person."